Number of measles infections each year from 2001 through 2014. Part of the reason for the resurgence is a rise in the number of parents who refuse to vaccinate their children against the virus. Despite an overwhelming amount of scientific and medical evidence demonstrating both the safety and efficacy of the measles vaccine, some parents refuse to vaccinate their children for reasons of personal belief. The problem is compounded because many like-minded parents are geographically clustered. For the entire state of California, the vaccine refusal rate is only 2.6%, indicating that most citizens are cognizant of the benefits of immunization. However, a recent study of pediatric health records revealed that in some areas the vaccine refusal rate is as high as 13.5%. Other factors such as a lack of time, education, or money can cause parents to inadvertently fall behind on their children’s immunizations.Disneyland provided an ideal starting point for an epidemic. In such a crowded atmosphere, a single infected individual might come in contact with hundreds or thousands of people in a day. Even if 90% of people are immunized, the virus’s high infectivity will allow it to spread through the population by jumping between susceptible individuals.How can I protect my children from getting measles?Get them vaccinated. CDC The United States is now experiencing what promises to be one of the worst outbreaks of measles since the virus was declared eliminated from the country in 2000. It began in early January at Disneyland Resort in Anaheim, California, and has since spread to 14 states and infected 84 people, according to the U.S. Centers for Disease Control and Prevention (CDC). Measles, caused by a paramyxovirus from the genus Morbillivirus, is one of the most contagious diseases in the world, infecting more than 90% of susceptible hosts that come in contact with an afflicted individual. In the absence of widespread vaccination, the average person with measles will infect an average of 12 to 18 other people; in contrast, Ebola is typically transmitted to 1.5 to 2.5 people. Children, in particular, are more likely to experience complications as a result of a measles infection. Although the overall mortality rate for children who get measles is only between 0.1% and 0.2%, as many as one out of every 20 children will also develop pneumonia. The disease symptoms can be managed with common anti-inflammatory drugs, hydration, and rest, but like many other viral illnesses, there is no cure and antibiotics will have no effect. Death rates are much higher in developing countries.What does measles do to the immune system?Measles virus is spread from person to person through the air in coughed-out aerosolized droplets that are inhaled. The virus typically first comes in contact with host lung tissue, where it infects immune cells called macrophages and dendritic cells, which serve as an early defense and warning system. From there, the infected cells migrate to the lymph nodes where they transfer the virus to B and T cells. A surface protein on these white blood cells, known as CD150, serves as the virus’s point of entry during this critical step. The infected B and T cells then migrate throughout the body releasing virus particles into the blood. The spleen, lymph nodes, liver, thymus, skin, and lungs are eventual destinations for the virus. In rare instances (about one in 1000 cases), the virus can cross the blood-brain barrier and cause dangerous swelling of the brain; infection of lung cells causes a hacking cough that keeps the virus circulating in the population.Sign up for our daily newsletterGet more great content like this delivered right to you!Country *AfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCote D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinianPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussian FederationRWANDASaint Barthélemy Saint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofVietnamVirgin Islands, BritishWallis and FutunaWestern SaharaYemenZambiaZimbabweI also wish to receive emails from AAAS/Science and Science advertisers, including information on products, services and special offers which may include but are not limited to news, careers information & upcoming events.Required fields are included by an asterisk(*)Why does measles cause a rash?One of the classic presentations of a measles infection is a rash characterized by flat red blotches that starts on the face and moves down the body all the way to the feet over a few days. The rash is a symptom of inflammation occurring in the skin. As the virus travels in the blood, it infects capillaries in the skin. Immune cells detect the infection and respond by releasing chemicals such as nitric oxide and histamines, which destroy the viral invaders and call other immune cells into action. These same chemicals, however, cause swelling and damage to host cells, resulting in the often itchy skin rash, which usually occurs concurrently with a fever that can reach as high as 40°C. Why is measles back?Measles has actually been back. Last year was one of the worst years in recent history for the United States: CDC reported 644 cases from 23 separate outbreaks during 2014; between 2001 and 2013, no single year saw more than 250 cases. (Because measles was declared “eliminated” in the United States in 2000, outbreaks have been triggered by virus “imported” from other countries, which then finds an unvaccinated person.) With 84 people infected already in 2015, things are not off to the best start.
As Medicare Drug Plans’ Premiums Rise, Beneficiaries Should Check Their Options Meanwhile, the number of subsidized Medicare drug plans is dropping because of insurance market consolidation and federal rules discouraging duplicative options — leaving some seniors with fewer options from which to choose. Skilled-nursing facilities are seeking more say in how they contract with accountable care organizations as a new CMS rule for ACOs loosens the coverage policy for some Medicare patients, experts say. Under the ACO Track 3 program, which starts in January, post-acute providers hope to see more gain-sharing opportunities, said Mike Cheek, a senior vice president at the American Health Care Association, which represents SNFs, nursing homes and other post-acute providers. (Sandler, 11/21) Even though health problems forced Denise Scott to retire several years ago, she feels ‘very blessed’ because her medicine is still relatively inexpensive and a subsidy for low-income Medicare beneficiaries covers the full cost of her monthly drug plan premiums. But the subsidy is not going to stretch as far next year. That’s because the premium for Scott’s current plan will cost more than her federal subsidy. The 64-year-old from Cleveland is among the 2 million older or disabled Americans who will have to find new coverage that accepts the subsidy as full premium payment or else pay for the shortfall. (Jaffe, 11/23) This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Modern Healthcare: SNF Leaders Wary Of New ACO Rule A federal analysis released Friday illustrates how the Medicare program came to spend $20.9 billion a year on doctor-administered drugs. One-quarter of those drugs cost from $51,000 to $536,000 per person annually, according to a study by the Government Accountability Office, released by Rep. Chris Van Hollen (D., Md.). The study also said that by 2013 about 332,000 Medicare participants were obligated to pay out-of-pocket costs ranging from $1,900 to $107,000 a year for new drugs in the Medicare Part B program. (Burton, 11/20) The Wall Street Journal: GAO Study Illustrates Cost Of Doctor-Administered Drugs In Medicare The Associated Press: Experts Foresee Big Premium Increases For Medicare Drug Plan With time running out on open enrollment season, many seniors are facing sharply higher premiums for Medicare’s popular prescription drug program. The reason: rising drug costs have overtaken a long stretch of stable premiums. Beneficiaries have until Dec. 7 to see if there’s a lower-cost plan that will cover their medications in 2016. Consumer advocates and experts say it will pay to shop around this sign-up season. (Alonso-Zaldivar, 11/22) Earlier KHN coverage: Don’t Just Renew Your Medicare Plan. Shopping Around Can Save Money. (Jaffe, 1/15) Also, The Wall Street Journal reports on a GAO study of Medicare’s spending on doctor-administered drugs and Modern Healthcare reports on how skilled-nursing facilities are reacting to a new ACO rule – Kaiser Health News: Fewer Medicare-Subsidized Drug Plans Means Less Choice For Low-Income Seniors